Posted by viridis on January 14, 2003, at 4:44:29
In reply to Re: Generally numb and stupidlike on ssris?, posted by worrier on January 13, 2003, at 19:42:01
Hi Worrier,
Well, my psychiatrist didn't really offer a biochemical explanation for why some people can't tolerate SSRIs (although in general he's quite eager to discuss the mechanisms of action of meds, and is very knowledgeable).
When I first went to see him, I was severely anxious and in the midst of a bout of panic attacks. We discussed various approaches, and he was very definite that the first thing to do was to get the anxiety under control with benzos. I told him that I was also prone to depression, and had used Prozac intermittently, sometimes for months. He just sort of shook his head and said that Prozac is the last drug he'd consider for a patient like me, because in his experience it's the most anxiogenic of the ADs. Then I told him I'd recently been taking Wellbutrin, and he corrected himself and said that actually, that would be his last choice.
He suggested that we slowly try ADs once I was stabilized. After a few weeks of Klonopin and occasional Xanax, I was feeling vastly calmer, but still mildly depressed, so I asked about ADs. He suggested one more try with SSRIs, and recommended Zoloft (which he told me he had taken himself for depression, with good results). However, given my bad experiences with Prozac, he started me at a very small dose (12.5 mg/day). After about a week, I was feeling so strange and anxious, with my moods shifting wildly, that I called him and said I didn't think I could tolerate it. He didn't offer any spiel about startup effects etc. -- just said to stop taking it immediately (I already had).
When I saw him, I asked about the significance of my reaction, and he just said that I was obviously one of those people who can't tolerate SSRIs (not the first one he'd seen). He didn't seem to read a lot into it, and just said we'd have to explore alternatives.
Anyway, to make a long story short, we tried a few things; what worked best was Adderall in combination with the Klonopin (I'd previously been diagnosed with ADD; he picked up on the attentional issues too and agreed that I have adult ADD). It's helped me focus, enhances the calming effects of the Klonopin, and is a powerful antidepressant even though I'm not taking it primarily for that purpose. I also take Neurontin; my pdoc feels that it adds "background stability", and it certainly has no side effects.
I'd rate Klonopin as my primary AD, because it alleviates the anxiety that causes severe depression for me. Adderall seems to take care of sporadic, lower-level depression, and maybe the Neurontin is doing something too.
So, for me, SSRIs weren't the answer, although I can't say I tried all of them (and never would now). But I do have several friends who have had excellent results with SSRIs that include Prozac, Celexa, and Paxil, so obviously they work well for some people. Presumably, the responders are ones who need more serotonin in certain synapses, and I guess I have enough already. Something else is going on in my case, and serotonin certainly isn't the only neurotransmitter that affects mood.
poster:viridis
thread:135592
URL: http://www.dr-bob.org/babble/20030113/msgs/135787.html